Returns on investment from produce prescriptions to low-income patients for accelerating payment reform
Summary
Systemic injustices have led to lack of both food and nutritional security for low income, Black, indigenous and people of color (BIPOC). Consequently, low-income and BIPOC populations already had higher prevalence of food and nutritional insecurities and are at significantly higher risks for obesity, type 2 diabetes, hypertension, heart disease, stroke and diet-related cancers pre-pandemic. These challenges create a vicious cycle that strain our healthcare system and economy nationally and in the Carolinas. Efforts to create and expand reliable access to healthy foods for all, especially for low-income and BIPOC populations are needed to improve health outcomes, narrow disparities, and reduce costs for healthcare systems, payers and families (pre-pandemic costs average $1,400/year/food insecure person in NC). A barrier to adopting these programs is a lack of concrete evidence on the returns on investments (ROI). We aim to determine the ROI from a produce prescription program, with the goal of catalyzing the food as medicine movement among health payers. Produce prescription programs provide funds for fruits and vegetables (FV) to identified patients in the healthcare setting. These programs address food and nutritional insecurities by increasing food budgets and improving access to healthy foods. Reinvestment Partners (RP), a Durham-based non-profit, manages such programs for rural, low-income, and BIPOC communities across NC. RP’s model, RPRx, provides $40/month for FV to eligible participants in partnership with federally qualified health centers (FQHCs), local health departments, and Food Lion. Patients are enrolled at participating health providers, and funds are distributed electronically through Food Lion’s customer loyalty card monthly. With 500 stores across NC, many located in rural and lower-income communities, these programs give high-need patients increased access to healthy food. RPRx has received over $6M from the USDA and NC DHHS to serve ~42,000 participants since 2018. Our evaluations of the early stages of these programs show that 90% of participants are food insecure at enrollment and 80% of patients redeem their produce prescriptions. On average, participants spend $34/month of their allotted $40, increase FV purchases by 0.9 servings/person/day, and the nutritional quality of purchases improve during program participation. Moreover, higher program utilization was associated with higher FV spending, expenditure share and variety, plus fewer hospitalizations within a year of participation. What is not yet known includes: a) specific health-related outcomes associated with these changes; b) variation in dose-response by patient characteristics; and c) what mid-term and longer-term impacts these programs have on healthcare utilization and costs. Answering these questions is critical for articulating the impact and ROI of produce prescriptions to key healthcare stakeholders, including payers, providers, and administrators at the state and federal level while materially changing the lives of people who need access to nutritious food. Evidence from this work will contribute to systemic change in the healthcare system and increase the potential for produce prescriptions to become reimbursable services.